Factors that influence empirical antibiotic choice for multidrug-resistant gram-negative bacteria
Factors that influence the likely susceptibility of multidrug-resistant gram-negative bacteria and, therefore, empirical antibiotic choice are provided in Factors that influence the likely susceptibility of multidrug-resistant gram-negative bacteria. This information can be used to support antibiotic choice and, if possible, should be obtained before seeking advice from an infectious diseases physician or clinical microbiologist.
This information assists in identifying which bacteria the patient may have been exposed to and the likely resistance mechanisms used by the bacteria – this may affect empirical antibiotic choice.
The local environment and certain patient factors can be used to predict the likely resistance mechanisms used by bacteria. For patients suspected or confirmed to be infected with a multidrug-resistant gram-negative bacterium, obtain the following information (if possible) before seeking advice from an infectious diseases physician or clinical microbiologist:
- recent travel history (eg in the past 6 months) – acquisition of bacteria with specific resistance mechanisms is associated with travel to particular countries or geographic regions
- details of previous infection or colonisation with multidrug-resistant gram-negative bacteria, particularly within the past 6 months, including:
- relevant bacterium and its susceptibilities
- date of sample
- any plan for antibiotic management if infection were to develop
- whether the patient has taken an antibiotic recently (eg within the last 30 days)
- local antibiotic susceptibility data (eg local antibiogram), if available
- other local information on the epidemiology of resistance, including known outbreaks.